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Form 8874(K)-A - Notice Of Kentucky New Markets Development Program Tax Credit And Certification

8874(K)-A

*1400010320*

41A720-S81 (5-14)

Commonwealth of Kentucky

NOTICE OF KENTUCKY NEW MARKETS DEVELOPMENT

DEPARTMENT OF REVENUE

PROGRAM TAX CREDIT AND CERTIFICATION

KRS 141.433

➤ See instructions.

Name of Qualified Community

Federal Identification Number

Kentucky Corporation/LLET

Development Entity (CDE)

of CDE

Account Number (if applicable)

of CDE

–

Name of taxpayer making the qualified

Identification number of taxpayer

Kentucky Corporation/LLET

equity investment

Account Number (if applicable)

of taxpayer

–

Number and Street (taxpayer’s address)

Certified purchase price of

the taxpayer’s qualified equity

investment

City

State

Zip Code

Date the CDE received cash for

What type of entity is the taxpayer?

taxpayer’s qualified equity investment

¨ Individual

¨ Estate

¨ Trust

¨ General Partnership

¨ Corporation

¨ S Corporation

¨ Limited Liability Pass-through Entity

Mo.

Day

Yr.

Under penalties of perjury, I declare that I have examined this form, including all

accompanying documents and statements, and to the best of my knowledge and belief,

it is true, correct and complete.

______________________________________

Signature of executive officer of CDE

Date

__________________________________________________________________________________

Type or print name and title

Department of Revenue Use Only

1. Total Allowable Credit

(add lines 2a through 2g)

2. a. Allowable credit: Year 1

b. Allowable credit: Year 2

c. Allowable credit: Year 3 (7%)

d. Allowable credit: Year 4 (8%)

e. Allowable credit: Year 5 (8%)

f. Allowable credit: Year 6 (8%)

g. Allowable credit: Year 7 (8%)

The above tax credits are approved for each year.

By: ___________________________________________

Date: _____________________

Mail to Department of Revenue, Division of Corporation Tax, Station 52, 501 High Street, Frankfort, KY 40601–2103.

Form 8874(K)-A - Notice Of Kentucky New Markets Development Program Tax Credit And Certification

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